CAJ | 학술논문

目的探讨依托咪酯全凭静脉麻醉用于老年人手术的可行性。方法选取2012年2月至2014年2月进行手术治疗的老年病患90例，随机分为依托咪酯观察组和丙泊酚对照组，每组45例。两组患者均采用全凭静脉麻醉，观察组给予依托咪酯0.2~0.3 mg/kg静脉注射，对照组给予丙泊酚1.5~2.5 mg/kg静脉注射。手术中观察组以0.6~1.2 mg/（kg·h）的速度输注依托咪酯，对照组以4~8 mg/（kg·h）的速度输注丙泊酚。比较两组患者术前，术中，术后血浆皮质醇浓度、MMSE评分以及术后不良反应情况。结果两组患者两组患者术后1 d、3 d认知功能评分比照术前均有所下降，但在术后7d均已恢复正常，两组之间无统计学差异。两组患者术前血浆皮质醇浓度比较无统计学差异，两组患者手术后血浆皮质醇浓度均明显低于术前水平，且观察组血浆皮质醇浓度降低更明显。两组术后均有患者出现不良反应，两组间不良反应发生率无显著差异（ P ﹥0.05）。结论依托咪酯对于老年手术患者术后出现认知功能障碍的影响与丙泊酚并无差异，且两者对老年人患者围术期应激反应均有抑制作用，但依托咪酯强于丙泊酚。两组不良反应出现情况相似，依托咪酯并无特殊不良反应出现。故依托咪酯用于老年手术中全凭静脉麻醉安全，有效。
목적탐토의탁미지전빙정맥마취용우노년인수술적가행성。방법선취2012년2월지2014년2월진행수술치료적노년병환90례，수궤분위의탁미지관찰조화병박분대조조，매조45례。량조환자균채용전빙정맥마취，관찰조급여의탁미지0.2~0.3 mg/kg정맥주사，대조조급여병박분1.5~2.5 mg/kg정맥주사。수술중관찰조이0.6~1.2 mg/（kg·h）적속도수주의탁미지，대조조이4~8 mg/（kg·h）적속도수주병박분。비교량조환자술전，술중，술후혈장피질순농도、MMSE평분이급술후불량반응정황。결과량조환자량조환자술후1 d、3 d인지공능평분비조술전균유소하강，단재술후7d균이회복정상，량조지간무통계학차이。량조환자술전혈장피질순농도비교무통계학차이，량조환자수술후혈장피질순농도균명현저우술전수평，차관찰조혈장피질순농도강저경명현。량조술후균유환자출현불량반응，량조간불량반응발생솔무현저차이（ P ﹥0.05）。결론의탁미지대우노년수술환자술후출현인지공능장애적영향여병박분병무차이，차량자대노년인환자위술기응격반응균유억제작용，단의탁미지강우병박분。량조불량반응출현정황상사，의탁미지병무특수불량반응출현。고의탁미지용우노년수술중전빙정맥마취안전，유효。
Objective To research in stress response and early cognitive dysfunction in elderly patients in surgical TIVA applied etomidate. Methods The elderly patients in our hospital from February 2012 to February 2014 for surgical treatment of 90 people were randomly divided into two groups,etomidate observation group of 45 people,and propofol group of 45 people. The patients of two groups were first in turn given midazolam( 0. 5 mg/ kg),fentanyl(3 ~ 4μg/ kg)and vecuronium(0. 1mg/ kg)intravenously. The patients of observation group were given etomidate 0. 2 ~ 0. 3mg / kg intravenous injection. The patients of the control group were given propofol 1. 5 ~ 2. 5 mg / kg intravenously. Surgery group was given at a rate of 0. 6 ~ 1. 2 mg(/ kg·h)etomidate infusion,while that of the control group to speed 4 ~ 8 mg(/ kg·h)infusion of propofol. The postoperative plasma cortisol concentrations,MMSE score of two groups of patients before surgery were compared. Results The postoperative cognitive function score before surgery at 1d,3d has declined,but these scores have returned to normal after seven days. No significant difference between the two groups. There was no significant difference between the two groups of patients before surgery plasma cortisol concentrations, but the plasma cortisol concentrations of two groups patients after surgery were significantly lower than that of the preoperative level. Compared with the control group,the observation group were significantly lower in plasma cortisol concentrations. Conclusion The postoperative cognitive dysfunction of etomidate for elderly surgical patients did not show significant difference with propofol. Both method had inhibition of perioperative stress response in elderly patients,which was stronger than etomidate propofol. Therefore,etomidate surgery is safe and effective for total intravenous anesthesia in elderly patients.